Objectives
  • To understand the epidemiology and the controversies surrounding the screening of prostate cancer, including the evidence for and against the use of prostate-specific antigen (PSA) screening and the practical indications of serum PSA measurement in different clinical settings

  • To know about the increased use of robotic prostatectomy and newer techniques of radiation therapy in patients with localised disease

  • To be able to evaluate the emerging literature surrounding chemotherapy in hormone-sensitive prostate cancer for patients with metastatic disease

  • To understand the definition of castration-resistant prostate cancer (CRPC) and know about the novel therapies that have been developed and approved in the last decade

Awareness
  • Recognition of the role of observation, surgery and radiation therapy in the management of early-stage disease

  • Awareness of the importance of a multidisciplinary team approach in decision-making

  • Appreciation of the importance of histological grading and of the changes that have recently been proposed to the traditional Gleason grading system

  • Appreciation of the fundamentals of proper diagnosis in prostate cancer and the role of different staging techniques; there is increasing evidence for the use of magnetic resonance imaging (MRI) and novel types of positron emission tomography (PET) scanning (sodium fluoride (NaF), choline and prostate-specific membrane antigen (PSMA) scanning) that reveal more and often different disease than traditional technetium bone scans

  • Awareness of the side effects (such as decreased libido) and metabolic side effects and toxicities associated with androgen deprivation therapy

  • Awareness of the novel therapies that have been developed for CRPC and that CRPC remains driven by androgen receptor (AR) signalling and that AR alterations are likely selected during androgen deprivation therapy

  • Awareness of the changing paradigm in the treatment of hormone-sensitive metastatic disease and the trend towards early use of chemotherapy in association with androgen deprivation therapy in patients who present with widely metastatic disease

  • Awareness of the novel therapies that have been approved for patients with CRPC that have improved overall survival and of the bone-targeting agents which are approved in this setting

  • Appreciation of the increasing literature on prostate cancer heterogeneity and that 90% of metastatic CRPC patients harbour clinically actionable molecular alterations

  • Awareness of the emerging literature on active agents to treat patients with DNA repair defects

Knowledge
  • Knowledge of when and how to use the combination of hormonal therapy and radiation therapy in patients with locally advanced prostate cancer

  • Understanding of the lack of evidence to support early treatment in most patients (eg, for rising PSA), and familiarity with the evaluation of the evidence for and against intermittent treatment for patients with metastatic hormone-sensitive disease

  • Knowledge of the indications in hormone-sensitive metastatic disease for the use of chemotherapy in association with androgen deprivation therapy in fit patients who present with metastatic disease

  • Knowledge of the indications for and recognition of how to use and knowledge of the side effects of chemotherapeutic, hormonal and targeted agents as well as radio-isotope; some knowledge surrounding the mechanisms of resistance to these agents

  • Familiarity with potential histological evolution and clonal selection using new hormonal therapies, with the consequence of new histological features like neuroendocrine carcinoma and intermediate atypical carcinoma

  • Knowledge of the implications of the multidisciplinary approach and of the oncogeriatric approach in this tumour of the elderly

  • Understanding of how and when to use bone-targeted therapies and of the prevention and treatment of osteonecrosis of the jaw

Skills
  • Ability to recognise the indications for prostatectomy and radiation therapy in patients with localised disease and those for salvage radiation therapy after radical prostatectomy

  • Ability to determine the indication for imaging and new imaging techniques at biochemical relapse

  • Ability to discuss options for oligometastatic disease

  • Ability to follow the changing treatment guidelines for metastatic patients with hormone-sensitive disease, adding chemotherapy to androgen deprivation therapy

  • Ability to manage the treatment of metastatic CRPC and its side effects

  • Ability to manage the toxicities associated with novel AR-directed therapies

  • Ability to select second-line chemotherapy and to manage its toxicity

  • Ability to determine the indications for therapy with radioisotope for bone-only disease

  • Ability to diagnose and manage spinal cord compression, one of the most devastating complications of metastatic prostate cancer

  • Ability to contribute to a multidisciplinary team approach in the treatment of patients with prostate cancer